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End of the Line.

November 12, 2008

I don’t know what happened. Honestly, I don’t. I think of myself as a good diabetic, an observant one at the very least, so the fact that this happened is just mind-boggling. It’s almost painful to think about the damage that could have been caused to my blood vessels over the weekend, but the fact is that it happened and I want to make sure that it never happens again.

So what happened?

On Friday night while babysitting, I tested and rang in at 318 mg/dl, which was odd because I was 138 mg/dl only a couple hours earlier. I corrected and an hour later, after the kids had eaten, I made raviolis and a frozen breaded chicken, then a snack a few hours later. Before I went to sleep, I tested at 341 mg/dl. Not only had I not come down, I had actually gone up slightly. I thought it was a bit strange, but chalked it up to the handful of cereal that I snuck while waiting for the parents to come home (even though I had bolused for said cereal).

I went to bed assuming the correction bolus would work and I’d come down. But sometimes I get this sneaking suspicion that my body occasionally forgets what insulin is supposed to do.

I woke up feeling a little funny. Very tired. I tested my blood sugar. My jaw dropped. 505 mg/dl. There’s something about reading in the 500s that makes me want to cry.

It was bizarre, to say the least, but I knew I was at the end of my reservoir, so I changed my set and opened a new bottle of insulin (make a mental note of this! it’s important!). I did a correction bolus with my pump using the new insulin. A couple of hours later, I was 342 mg/dl.

Relieved to be coming down, I made two Eggo waffles and spread a light amount of apple butter on top. I bolused for sixty carbs (30 for the waffles, 30 for the apple butter). But a couple of hours later, when I tested again, I had spiked back up into the 400s! Okay, okay, maybe the apple butter was a bad idea, but with all the correction bolusing I was doing, you’d think I would have at least stayed the same (the idea being that the correction bolus would cover the food to keep me stable, instead of bring me down). I resorted to using an insulin injection, and just before leaving for the Gala, I was clocking in at 157 mg/dl.

The rest of the night would not be so easy. Going out to a party is always difficult, but because of my roller coaster day I actually tried to refrain from eating too many carbohydrates and tried to walk around to burn off some of the sugar. I tested periodically throughout the evening, and each time I was in the 400s. I simultaneously was bolusing for food (as best as I could) and took correction doses.

Aren’t correction boluses supposed to bring you down? Apparently not. By the time I got home, I was at a staggering 457 mg/dl. I changed my set and gave another correction bolus, and two hours later, I was up to 464 mg/dl. No movement. Whatsoever.

Seriously, my body was defying science. You give insulin, blood sugar goes down. Right? It wasn’t until 3 in the morning that my body finally hit… 376 mg/dl.

When I woke up the next morning, I was 360 mg/dl. All that insulin and yet nothing. After another round of set-changing and triple-checking that insulin was coming out of the tubing (so no leaks), I decided to take another insulin injection. A few hours later and I was back down to 166 mg/dl.

I stayed in the 100s until I decided to have dinner. Big mistake. I only had pasta (and this is something I eat every day so I have it down to a science) for dinner and little while later popping a bag of popcorn while watching television. Bed time reading? 532 mg/dl. My highest of the weekend.

I spent the next few hours trying to drag my blood sugar back down to earth, fearing what might happen if I woke up for work the next day in the 500s. I also tested for ketones, which I had neglected to do because I didn’t have any plastic cups (hey, I’m a girl. I’m not that talented). As I tweeted my grievances throughout the night, receiving some very thoughtful responses, I eventually hit 187 mg/dl at 1 a.m.

So I went to bed.

When I woke up? 73 mg/dl.

Obviously.

I’m still struggling with some trips to the 300s, but for the most part I’m staying pretty close to normal range. I know my basals and bolus ratios need tweaking, but it doesn’t negate the fact that this weekend did not make sense.

On Monday, I was done. Fed up. No longer was I going to put up with waking up to find myself at 505 mg/dl. I should have known earlier what was going on. Seen that my blood sugars were not coming down. I should not have to wait two to three hours before testing to see if any change is being made.

So I called Minimed. And I told the customer service representative that I wanted a continuous glucose monitor. As luck would have it, I am with one of the best insurance companies to get a CGM (United Healthcare). I spoke to a CGM representative and the request to upgrade my insulin pump to the Minimed 722 is currently being processed. I should have a new pump by the end of the month. If everything goes swimmingly, I should have a month’s worth of sensors by the end of the year.

Some people have impossible low blood sugars. Me? I have impossible high blood sugars. Some people don’t feel low blood sugars. I don’t feel high blood sugars until I’m in the upper 300s or 400s. That’s unacceptable. That does just as much – if not more – damage to someone. The bouncing needs to stop. I am not a tennis ball.

This is the end of the line for the snapshot diabetes management. It’s time for the age of proactive diabetes management to begin.

16 Comments
  1. November 12, 2008 4:24 PM

    Oy, what a ride😦 Good luck with the CGM!

  2. November 12, 2008 5:13 PM

    I hate that Allison. Keeping my fingers crossed for you too!

  3. November 12, 2008 5:46 PM

    Awww Allison…Im sorry you’re having those nasty highs! We’re going thru that with Kacey now and its VERY frustrating! Hope things get better🙂

  4. November 12, 2008 5:47 PM

    Good luck with CGMS. I love mine. I’m sorry you had such a crappy day. I HATE days like that. All I want to do is sleep. 😦

  5. November 12, 2008 6:11 PM

    Oye! Sorry to hear you went through that.

    I’m normally very hypo rather than hyper (I can’t count the # of times I have been 23 – yes, two-three, and felt absolutely fine), but I had a similar bout of unexplainable highs last year. Now, I had been a strict vegan since age nine *until* last year when I fell off the wagon and started eating meat again … then my basals and carb ratios kept going up and up and I still couldn’t make numbers in the 300s budge.

    I happened to come across some research at the time on how [eating] fat affects insulin resistance, so I tried an experiment and planned a week of consuming less than 20g of fat per day. Wham-o, my basals plummeted (I was actually crazily severely low, drinking an entire bottle of juice in a day). I’ve tried this experiment multiple times and, for me at least, just two meals of meat + cheese (say, a calzone) will send my blood sugar skyward where it will refuse to come down. Might be something to experiment with to see if it affects you at all. (I use a free program called Cron-O-Meter from http://www.spaz.ca to track nutritional information.)

    The CGMS is an awesome tool the first time around. (Although, I – seriously – recommend getting tipsy before inserting that needle. It’s evil-looking.) Being able to stop a high in its tracks – when it was 160 and not 260 – was amazing. However, after awhile I got my basals and ratios down tight and stopped using the CGMS full-time. My endo (who is also type 1) said it’s pretty normal for patients to get tired of it – so now I use it on and off (which makes it more affordable, too).

  6. November 12, 2008 7:04 PM

    Oh my god, Allison, you’re like me! Once my blood sugar gets up that high it seems to take forever to come back down. I’d really love to get a CGM but I don’t know if my health insurance covers it, or if I qualify to get one in the first place. I’ll have to ask my endo next time I see her what she thinks.

    If it makes you feel better, I can’t feel/tell when I’m above 200 mg/dL either. Other people can, because I apparently get kind of, or really, bitchy, but to me I don’t notice any differences in my behavior. It’s weird, and worries me sometimes when I think about moving out on my own…. If no one is around to tell me I’m high, will I notice? I don’t get any symptoms either until I’m above 400 mg/dL, then I start to get a headache. (Which I sometimes attribute to stress or lack of sleep, argh.) Lows for me, however, are easy to identify, I start feeling “wiggly,” like I’m going to pass out.

  7. November 12, 2008 9:52 PM

    Wow. I’d be annoyed and pissed with those numbers too.

    Good luck with the CGM!

  8. November 13, 2008 6:51 AM

    Haven’t dropped by in some time Allison, but sorry to hear your numbers are way out. Your young and strong, I doubt there was any real long term damage done, especially if you can get this under control quickly. I know the CGMS is bound to help immensely.

    I’ve found I’m having to increase pre-bedtime boluses by 150% in order to be even somewhat effective. Sometimes that doesn’t even work well. As Marina eluded to above, the fat content in a particular meal can now throw me for a loop as well.

    Congrats on the CGMS!

  9. November 13, 2008 8:32 AM

    Allison, what a horrible weekend. I can’t imagine how exhausted you must have felt after all that. On my Cozmo I can change the correction factor so that if my bg is above 300 I get a higher dose, that helps. I also use the super bolus (several times a week) and that helps get things down faster.

    Anyway, once you have a CGMS you’ll find things are a lot easier. I hope you see the same kind of improvements that I have!

  10. November 13, 2008 11:23 AM

    Major suckage. Major.

    Glad you are mostly back on track, you should find some time to get some rest (you’re not busy ever are you?). I’m sure that weekend really wiped you out.

  11. November 13, 2008 12:01 PM

    Ha. I think the phrase “run over by a truck” fit pretty well on Monday. I was such a sludge. Usually a random high doesn’t do much, so it caught me a little off-guard how awful I would feel. I’m doing a lot better though, so thanks everyone!

  12. Paula P. permalink
    November 13, 2008 11:03 PM

    Allison,
    So sorry to hear about your rough weekend. I’m the mom of an 8 y.o.d. I found out about your blog after a friend read about it in The Times, I think. Anyway, I think I read on another blog recently (SUM?) that you can trick your body by giving tiny amounts of insulin to bring it down, rather than the large amounts.
    Good luck.

  13. November 14, 2008 8:49 AM

    Allison, as a Medtronic Diabetes employee I should point out our “2 High BG” rule, which is when you get two consecutive high readings to not only change out your infusion site (which it sound slike you did) but also take a correction bolus manually. Your health is our chief concern, and feel free to call our 24 Helpline anytime for assistance.

  14. November 14, 2008 9:20 AM

    J-med: I did change my set (three times) and I also took 2 correction doses by injection. Those were the only times my blood sugar came down to 100s and thinking I solved the problem, continued as normal. But then my blood sugar would skyrocket back up. The correction injection (hey that rhymes!) only did so much to help me, but I appreciate your concern. I think this was one of those bizarre moments that no one will be able to figure out. But props to Minimed for reaching out to bloggers.

  15. November 19, 2008 3:11 PM

    I know EXACTLY what you mean. I had 2 readings >500 and woke up twice with readings in the 300s this past week. Those >500s feel like someone kicked me in the shins and called me a dumb loser then laughed and ran away — basically making me want to cry.

    Sorry to hear you’ve had all that trouble, and I hope the CGM comes through for you soon!

    I got a Dex back in Sept. but have been out of sensors for about a month now and fighting with my suppliers to get new sensors. Long story, short: they had my CGM order in a different account with a misspelling. Very frustrating.

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